腹部恶性肿瘤患者放疗物理参数与肠道菌群改变对继发放射性肠炎风险的影响  

Effects of physical parameters of radiotherapy and changes in intestinal flora on the risk of secondary radiation enteritis in patients with abdominal malignant tumors

作　　者：冯欢[1] 王博[1] 张龙 杨晨 林丽慧 FENG Huan;WANG Bo;ZHANG Long;YANG Chen;LIN Lihui(Radiotherapy Department,Puyang Anyang District Hospital,Puyang 455000,China;Radiotherapy Department,Anyang Cancer Hospital,Anyang 455001,China)

机构地区：[1]濮阳市安阳地区医院放疗科,河南濮阳455000 [2]安阳市肿瘤医院放疗科,河南安阳455001

出　　处：《中国医科大学学报》2024年第11期1025-1030,1035,共7页Journal of China Medical University

基　　金：河南省医学科技攻关计划(联合共建)项目(LHGJ20200808)。

摘　　要：目的探讨腹部恶性肿瘤患者放疗物理参数与肠道菌群改变对继发放射性肠炎(RE)风险的影响。方法选取濮阳市安阳地区医院2020年4月至2023年8月收治的98例腹部恶性肿瘤放疗患者,分为RE组(n=26)和无RE组(n=72)。比较2组临床资料、放疗物理参数及肠道菌群改变,Pearson分析放疗物理参数与肠道菌群改变的相关性,logistic回归分析放疗物理参数、肠道菌群改变与继发RE风险的关系,受试者操作特征(ROC)曲线及曲线下面积(AUC)分析放疗物理参数、肠道菌群改变预测继发RE风险的价值。结果RE组小肠V20、V40、2 cm^(3)所受剂量(D2cc)、直肠D2cc、结肠D2cc高于无RE组(P<0.05);RE组放疗第3周肠道菌群α多样性Chao1指数、Shannon指数、Simpson指数低于无RE组,RE组放疗前后肠道菌群α多样性Chao1指数、Shannon指数、Simpson指数下降幅度大于无RE组(P<0.05);小肠V20、V40、D2cc、直肠D2cc、结肠D2cc与肠道菌群α多样性Chao1指数、Shannon指数、Simpson指数放疗前后下降幅度呈正相关(P<0.05);logistic回归分析结果显示,小肠V20、V40、D2cc、直肠D2cc、结肠D2cc、肠道菌群α多样性Chao1指数、Shannon指数、Simpson指数下降幅度是继发RE的独立危险因素(P<0.05);放疗物理参数、肠道菌群改变联合预测继发RE风险的AUC为0.920,大于各指标单独预测。结论腹部恶性肿瘤患者放疗物理参数与肠道菌群改变密切相关,可共同增加继发RE风险,其联合预测继发RE风险具有较高价值。Objective To investigate the effects of the physical parameters of radiotherapy and intestinal flora on the risk of secondary radiation enteritis(RE)in patients with abdominal malignant tumors.Methods Ninety-eight patients with malignant abdominal tumors who were treated with radiotherapy from April 2020 to August 2023 at Anyang District Hospital in Puyang City were selected and assigned to the RE group(n=26)or the non-RE group(n=72).The clinical data,physical parameters of radiotherapy,and changes in the intestinal flora were compared between the two groups.Pearson’s correlation analysis was used to determine the correlation between the physical parameters of radiotherapy and changes in the intestinal flora,and logistic analysis was used to analyze the relationship between the physical parameters of radiotherapy,changes in the intestinal flora,and risk of RE.The receiver operating characteristic(ROC)curve and the area under the curve(AUC)were used to analyze the physical parameters of radiotherapy and changes in intestinal flora in predicting risk of RE.Results The doses of V20,V40,and D2cc in the small intestine,D2cc in the rectum,and D2cc in the colon were higher in the RE group than in the non-RE group(P<0.05).Theαdiversity Chao1 index,Shannon index,and Simpson index of the intestinal flora in the RE group were lower than in the non-RE group,at the third week of radiotherapy,and the decrease in theαdiversity Chao1 index,Shannon index,and Simpson index of the intestinal flora in the RE group was greater than in the non-RE group,before and after radiotherapy(P<0.05).The doses of V20,V40,and D2cc in the small intestine,D2cc in the rectum,and D2cc in the colon were positively correlated with decreases in theαdiversity Chao1 index,Shannon index,and Simpson index of the intestinal flora,before and after radiotherapy(P<0.05).The logistic analysis showed that the decrease in V20,V40,and D2cc in the small intestine,D2cc in the rectum,D2cc in the colon,αdiversity Chao1 index,Shannon index,and Simpson index of the

关 键 词：腹部恶性肿瘤 放疗物理参数 肠道菌群 放射性肠炎 

分 类 号：R749.16[医药卫生—神经病学与精神病学]